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. 2024 Aug 16;14(8):865.
doi: 10.3390/jpm14080865.

General Anesthesia Improves Efficiency of High-Power Short-Duration Catheter Ablation for Atrial Fibrillation: Comparison with Mild Conscious Sedation

Ioan-Alexandru Minciună  1   2 , Raluca Tomoaia  1   2 , Mihai Suceveanu  2 , Gabriel Cismaru  1   2 , Mihai Puiu  2 , Radu Roșu  1   2 , Gelu Simu  1   2 , Diana Andrada Irimie  1   2 , Florina Frîngu  1   2 , Bogdan Caloian  1   2 , Marius Andronache  3 , Dumitru Zdrenghea  1 , Dana Pop  1   2
Affiliations

General Anesthesia Improves Efficiency of High-Power Short-Duration Catheter Ablation for Atrial Fibrillation: Comparison with Mild Conscious Sedation

Ioan-Alexandru Minciună et al. J Pers Med. .

Abstract

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia globally. High-power, short-duration radiofrequency (RF) catheter ablation (CA) for AF has recently emerged, reducing ablation times and enhancing patient tolerability with comparable efficacy and safety. While the benefits of general anesthesia (GA) for standard-power, standard-duration CA are well-established, data comparing GA to mild conscious sedation (MCS) for high-power, short-duration CA are limited.

Methods: We included patients undergoing high-power, short-duration CA for AF under GA (group 1) or MCS (group 2). Procedural characteristics, success rates, and mid-term outcomes were compared.

Results: In total, 131 patients, 47 in the GA group and 84 in the MCS group, were included. CA was performed for paroxysmal AF in 34 patients in group 1 (72.3%) and 68 patients in group 2 (80.9%). We found lower a mean total procedure time (100 [90-120] vs. 160 [130-180] min, p < 0.0001), lower radiation exposure (932.5 [625-1716] vs. 2445 [1228-4791] μGy, p < 0.0001 and 4.5 [3-7.1] 7.3 [4.2-13.5] min, p = 0.0003) and fewer RF applications (71 [54.8-83.8] vs. 103 [88.5-120.5], p < 0.0001) in the GA group. No major complications occurred. The 6-month AF recurrence rate was comparable between the groups (21.2% vs. 33.3%, p = 0.15).

Conclusion: In patients undergoing high-power, short-duration RFCA for AF, the use of GA is associated with better procedural efficiency while simultaneously associated with an early recurrence rate comparable to MCS.

Keywords: atrial fibrillation; catheter ablation; general anesthesia; high-power short duration; mild conscious sedation.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Comparison of procedural efficiency parameters between the two groups. (A) Radiation exposure—dosis (mGy); (B) radiation exposure—time (min); (C) total procedural time (min); and (D) number of radiofrequency (RF) applications.
Figure 2
Figure 2
Comparison of procedural efficiency parameters between the two groups for paroxysmal AF patients. (A) Radiation exposure—dosis (mGy); (B) radiation exposure—time (min); (C) total procedural time (min); and (D) number of radiofrequency (RF) applications.
Figure 3
Figure 3
Comparison of procedural efficiency parameters between the two groups for persistent AF patients. (A) Radiation exposure—dosis (mGy); (B) radiation exposure—time (min); (C) total procedural time (min); and (D) number of radiofrequency (RF) applications.
Figure 4
Figure 4
Comparison of AF recurrence at 6-month follow-up between the two groups. (A) Overall; (B) paroxysmal AF; and (C) persistent AF.
See this image and copyright information in PMC

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